Heroin Abscess (Photos + Treatment)

Clinical Reviewer

An abscess is a mass beneath the skin that is filled with pus and bacteria. Abscesses form when bacteria get underneath the skin and cause an infection.

Visual of an Abscess Under the Skin

Abscess Under the Skin

Why do heroin users get abscess?

People who inject drugs like heroin get abscesses when a needle puncture introduces bacteria within the layers of the skin or just underneath the skin.

The bacteria that cause abscesses can come from:

Abscesses are common among IV drug users. Substance Use & Misuse Medical Journal reports one in three IV Drug users had a recent abscess.

Abscesses are associated with heroin, but shooting up any drug can cause an abscess or track marks.

What do abscess from IV drug use look like?

Abscesses start out looking somewhat like a pimple, but escalate to a life-threatinging emergency.

Early Heroin Abcess

Stage 1 

Abscesses from drug use start as a small, raised bump that is slightly redder than the surrounding skin. The abscess can be treated at home at this stage, but don’t pop an abscess.

Typical Heroin Abcess

Stage 2 

As the infection gets worse, the bump grows larger with a round or oval shape, redness and swelling. At the center, the abscesses look like a pimple, and some of the pus within may be visible.

Advanced Heroin Abcess

Stage 3 

If not drained and treated, the abscess becomes an open wound and the infection spreads through the bloodstream. At this stage, the abscess is a medical emergency.

Severe Heroin Abcess

Stage 4 

Tissue surrounding the abscess begins to die and vital organs become infected. The skin turns darker red, eventually turning purple, green and even black as tissue decays.

What are heroin abscess symptoms?

Most symptoms occur in the area where the heroin was injected, including:

If you notice these symptoms, the bacteria is spreading throughout the body and requires medical treatment:

Treating a Heroin Abscess

Whether a patient needs medical treatment for an abscess depends on the symptoms. 

SymptomsWhat to Do
– Minor redness and swelling immediately after injection
– No bump or raising 
This is not an abscess. Stop injecting in the area and use a warm compress. Keep the skin clean with soap and water.
– Injection site is bright red and raised
– Area is swollen, itchy or painful
Stop injecting in the entire limb. Keep the area clean with soap and water. Watch closely for any changes.
– Abscess is larger than 1/4 inch diameter, and getting larger
– Injection site is red, hot and very painful
Get treatment from a medical professional. They can help score and drain the abscess to prevent the infection from getting worse or spreading and give antibiotics.
– Chills, fever or swollen lymph nodes
– Limb becomes pale or blue
Go to the Emergency Room immediately. The infection is spreading and could already be impacting your vital organs.

What is the treatment for a heroin abscess?

The treatment for a heroin abscess involves antibiotics and usually draining

To drain an abscess, doctors make an incision clean out the pus, then pack the open wound with gauze and allow it to heal. Abscesses that aren’t drained can rupture, causing pus to leak out. This creates an open wound that is even more vulnerable to infection.

Pus Draining from Heroin Abscess

Pus Draining from Ruputured Abscess
Pus is made up of white blood cells that protect the body against infection.

Can you do heroin abscess drainage at home?

Do not pop an abscess or attempt to drain it at home. You are likely to cause further damage to the skin and make the infection spread faster. ⓘ 

To temporarily relieve abscess pain and swelling:

Trying to deal with a serious abscess at home is how people end up with life-threatening complications like sepsis. 

What happens if a abscess from shooting up goes untreated?

An abscess does more than just damage the skin. Within days, it can spread bacteria throughout the body causing infections in the blood, heart and other vital organs. Abscesses can become life-threatening if not treated. ⓘ 

But, when properly treated with antibiotics and draining, abscesses heal within a few weeks.

Side-Effects of Infected Herion Abscess

Side Effects of Abscess Include Sepis and Endocarditis

Treating the Underlying Drug Addiction

Abscesses caused by drug use are a symptom of another life-threatening medical issue – drug addiction. Treating your abscess and preventing any future complications means treating the addiction that caused the abscess too.

Get help for your physical symptoms and address the underlying factors fueling the cycle of addiction.

Start Heroin Detox & Treatment Today

Symetria doctors follow rigorous sourcing guidelines and cite only trustworthy sources of information, including peer-reviewed journals, court records, academic organizations, highly regarded nonprofit organizations, government reports and their own expertise with decades in the field.

Baiu, I., & Melendez, E. (2018). Skin Abscess. JAMA, 319(13).

Callahan, T., Schecter, W., & Horn, J. (1998). Necrotizing Soft Tissue Infection Masquerading as Cutaneous Abscess Following Illicit Drug Injection. Archives of Surgery, 133(8), 812–818.

Fink, D. S., Lindsay, S. P., Slymen, D. J., Kral, A. H., & Bluthenthal, R. N. (2013). Abscess and self-treatment among injection drug users at four California syringe exchanges and their surrounding communities. Substance use & misuse, 48(7), 523–531.

Gilbert, A.R., Hellman, J.L., Wilkes, M.S. et al. Self-care habits among people who inject drugs with skin and soft tissue infections: a qualitative analysis. Harm Reduct J 16, 69 (2019).

Lavender, T. W., & McCarron, B. (2013). Acute infections in intravenous drug users. Clinical medicine (London, England), 13(5), 511–513.

Murphy, E. L., DeVita, D., Liu, H., Vittinghoff, E., Leung, P., Ciccarone, D. H., & Edlin, B. R. (2001). Risk Factors for Skin and Soft-Tissue Abscesses among Injection Drug Users: A Case-Control Study. Clinical Infectious Diseases, 33(1), 35–40.

NIDA. 2021, April 13. What are the medical complications of chronic heroin use?. Retrieved from https://www.drugabuse.gov/publications/research-reports/heroin/what-are-medical-complications-chronic-heroin-use on 2021, June 11

Pieper, B., & Hopper, J. A. (2005). Injection drug use and wound care. The Nursing clinics of North America, 40(2), 349–363.

Russell, F. M., Rutz, M., Rood, L. K., McGee, J., & Sarmiento, E. J. (2020). Abscess Size and Depth on Ultrasound and Association with Treatment Failure without Drainage. The western journal of emergency medicine, 21(2), 336–342.

All content is for informational purposes only. No material on this site, whether from our doctors or the community, is a substitute for seeking personalized professional medical advice, diagnosis or treatment. Never disregard advice from a qualified healthcare professional or delay seeking advice because of something you read on this website.

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  • My 32 yo son who has a history of heroin use has sores and swelling around his feet and ankle. He says that he is not using. Is this a concern?
    He says that he spilled hot liquid on his feet. That’s was months ago.

    1. The sores could be from many different things depending on what they look like, their number, exact locations, if they are changing/healing, etc. The sores may be due to intravenous drug use. If he has a history of using heroin intravenously and has been injecting it into veins in his legs, this can damage the veins causing scarring and blockage, which then results in swelling around the feet and ankles. I would be concerned that he returned to substance use given the history you’ve provided. People who use illicit substances often feel very ashamed, and it is natural for them to lie or deny their use. If you approach him about it in a caring, non-judgmental, non-shaming way, he will be more likely to be honest and you both can work from there to help him get the care he needs. If he still insists that the swelling wounds on his feet and ankles are from spilling hot liquid, it is not normal for him to continue to have sores and swelling from that, especially if it occurred several months ago. I would recommend he seek medical evaluation for that.

    1. Yes. Once bacteria reaches your blood supply, it can spread and “seed” to other areas of the body that were not the original location of the injection and can develop abscesses there.

    1. Black drainage seen in an abscess is most likely due to dead tissue. If the material is dry and firm, then it is most likely just an aged scab.

  • My 42 you son has a huge abscess on the inside of his left wrist, he used a razor blade and cut it, he said he couldn’t stand the pain anymore & needed some relief, he has put peroxide mixed with water, soaked it in Epsom salt, used warm compresses,I put dressings on it for him I put triple antibiotic ointment it,There was a yellowish thing hanging from it, he asked me to cut it off at the skin, I did, but the hole keeps getting bigger, idk what else to do for him, he waited until it red, swollen and painful before he said anything about it I’ve told him to go to the hospital or Dr because it looks like it’s eating down to the bone, he says he needs to go, but won’t go,Idk if it’s from heroin or meth

    1. Take him to the emergency room before he loses his limb or even worse his life! That is really bad what you described, go!!!!!!!

    1. Most often it would appear anywhere from 2 days to up to 2 weeks after IV heroin use.

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